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Exact Sciences · 1 day ago

Patient Financial Services Associate II

United States

Full-time

Remote

Entry, Mid Level

$43K/yr - $65K/yr

2+ years exp

Exact Sciences is dedicated to changing how the world prevents, detects, and guides treatment for cancer. The Patient Financial Services Associate II is responsible for processing claims, appeals, and denials while ensuring accurate billing and communication with insurance payors for optimal account receivable outcomes.

BiotechnologyHealth DiagnosticsManufacturingMedical

No H1B

Responsibilities

Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic; including updates to patient demographics, financial information, and guarantor information

Ability to interact with various insurances and third-party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations

Research missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors

Review/edit claims and appeals prior to submitting to clearinghouse

Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence

Correct rejected claims from the claim’s scrubber, clearinghouse, or payor

Review explanations of payments, analyzes, and completes appropriate steps for all denials by appropriately identifying claim resolution next steps; including appealing, writing off, or sending statements

Investigate payor underpayments

Follow up with payors via phone on unpaid aging claims

Reviews denials and determines appropriate next actions; such as sending appeals or patient statements

Provide any supporting documentation needed by insurance payor

Perform accurate and timely write-offs following identification of uncollectible accounts adhering to policies and guidelines

Participate in regularly scheduled team meetings sharing denial trends specific to claim requirements to enhance front end claim edits to facilitate first pass resolution. Contribute ideas for workflows and best practices to maximize opportunities for performance, process, and net revenue collections improvement

Provide ad-hoc support, as necessary, within the department (i.e., special projects, provide support due to outages/high volume)

Complete position responsibilities within the appropriate time frame while adhering to quality standards

Stay current with relevant medical billing regulations, rules, and guidelines

Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations

Excellent problem-solving abilities and organizational skills

Ability to communicate effectively with all levels of staff through both verbal and written communications

Ability to work in a team environment

Ability to adapt to changing workload and circumstances effectively; able to respond to new information quickly

Disciplined, self-motivated, and reliable

Ability to stay focused on a task and work independently; motivated to perform quality work

Diligent about arriving to work on time and completing tasks that are assigned in a timely manner

Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates

Possess a positive attitude

Work with others in a spirit of teamwork and cooperation

Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork

Support and comply with the company’s Quality Management System policies and procedures

Regular and reliable attendance

Ability to work normal schedule of Monday through Friday during normal business hours

Ability to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day

Ability to work on a computer and phone simultaneously

Ability to use a telephone through a headset

You will be required to successfully complete an assessment showing understanding of Exact Sciences Epic processes necessary to the job functions with a score of 80% or higher. Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement

Qualification

Medical billingClaims processingInsurance knowledgeEpic softwareEHR systemsKeyboarding skillsAttention to detailCommunication skillsTeamworkProblem-solving

Required

High School Diploma or General Education Degree (GED)

2 years of experience in medical billing, claims, and/or insurance processing

Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes

Knowledge of medical terminology and/or health insurance terms

Knowledge of EHR operating systems and work involving electronic records

Proficient in computer systems and keyboarding skills

Demonstrated strong attention to detail and focus on quality output

Demonstrated ability to perform the Essential Duties of the position with or without accommodation

Authorization to work in the United States without sponsorship